The Stigma of Mental Illness: An Evolutionary Account

Lotus: purity and healing

Eric Chen

Why are people with mental illness stigmatized? Understanding the factors underlying stigmatisation is important in tackling the problem. Is it because of a lack of information about mental illnesses? Or is there a deeper root?

Stigmatization refers to a phenomenon whereby based on a few characteristics, people are categorized into groups and treated in similar fashions (usually in a negative manner). Negative stigma towards people with mental illness is an important obstacle to the detection, engagement, and treatment of mental disorders.

Originally stigma referred to a visible sign, for example, skin lesions in leprosy. Stigmatization is closely related to stereotyping. In stereotyping, we infer unknown characteristics of people by classifying them into groups based on a few observable features. In this way, biases and lack of individual understanding led to blanket treatment (discrimination) of people disadvantaged in the process.

Stigma, stereotypes, and categorical thinking

Underlying stereotyping is categorical thinking. Categorical thinking originally was an adaptive mental ability to handle the diversity of objects around us effectively by grouping items of similar appearance and interacting with them in a similar way.

This works well for natural objects like plants and animals (e.g. colourful mushrooms are poisonous). However, as humans developed more sophisticated communities, the mind also has to deal with increasingly complex social information. Categorical thinking may be inadequate in social cognition.

The evolutionary origin of stigma

Group psychology is an important aspect of social cognition. Human beings have a strong need to function within identifiable social groups in a primarily cooperative manner. In cooperative groups, each member has a high level of trust in other members. This enables adaptive altruistic cooperative behaviour in the group. In this context, however, a small number of individuals can thrive with cheating behaviour and can extract considerable advantages from the group before they are detected and expelled.

As the social organisation of human groups increases in size and complexity, the chances of a social encounter with people one does not have longstanding knowledge of (i.e. strangers) increases. Evolutionary psychology reveals that human beings have specific cognitive tendencies to detect cheating individuals. One protection is a strong bonding between members within the group and being cautious about individuals outside the group. Recognition of “foreign” individuals is based on appearances, lack of shared language and shared information. When categorical thinking is applied to social cognition in this context, stereotyping and stigmatization will result. Stigmatisation, therefore, may have an intrinsic origin and is expected to be deep-rooted. Addressing stigmatisation would require the intentional altering of some basic human tendencies.

Stigma and secrets

Stigmatisation is applied to people with visible signs that mark them as a group. Race, skin disease and disorganized behaviour provided obvious outward signs. Mental illness is often associated with disorganized behaviour. The threat of violence is also behind a strong emotional link with the stereotype of mental disorders. When applied to mental illness, many people with mental illness do not have a visible sign. The “sign” becomes closely related to the self-disclosure of help-seeking and treatment for mental disorders. The situation creates a field of secrecy in which the person has to manage who knows about what. This need for managing a secret can be a considerable psychological strain, particularly for people who are sensitive to others having negative perceptions of themselves.

Therefore purely assuming that a lack of knowledge is the main cause of stigmatisation is perhaps too simplistic. Indeed studies have shown that increased dissemination of scientific knowledge of mental disorders is not associated with a reduction in stigmatisation.

Combating stigma with personal contacts

Recognising the deeper roots of stigmatisation enables a more systematic approach to reducing it. Currently, approaches to reducing stigma aim at increasing contact with people who have mental illnesses or have recovered from mental illnesses. In this way, people are known as individuals with many traits that are not necessarily related to their mental illness experiences. This approach to presenting the more individualized aspect of a person reminds us not to simply categorize people based on a small amount of information about them.